Brain metastasis in NSCLC patients: Mechanism, diagnosis and treatment
Journal
International Journal of Cancer Research and Prevention
Journal Volume
5
Journal Issue
43894
Pages
321-346
Date Issued
2012
Author(s)
Abstract
Brain metastases develop frequently in non-small cell lung cancers (NSCLC), and cause poor prognosis and rapid neurologic function deterioration. The physiopathological mechanism for metastases to the brain is elusive. It might be associated with molecular, angiogenesis and neurovascular interactions. Brain imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), could be used to detect brain metastases, even in asymptomatic patients. Some clinical factors and molecular markers, e.g. neuron-specific enolase (NSE), had been evaluated for their association with brain metastasis. In addition, clinical factors, such as age and performance status, and prognostic scoring, e.g. recursive partitioning analysis (RPA) and graded prognostic assessment (GPA), have been found to be helpful in making clinical decisions. Use of other indicators has been controversial. Recent advances in the management of brain metastases have resulted in improvement of neurological function and prolonged survival. Whole brain radiotherapy (WBRT) is the most widely used. It increases average survival time from approximately 1 month to 3-4 months. For patients with solitary brain metastasis, especially in patients with good performance status, a radical treatment approach, involving surgical resection or stereotactic radiosurgery (SRS), followed by WBRT gives patients survival benefit, with increases local control rate, and decreased intracranial recurrence. Because the benefit of SRS is comparable to surgical resection, the choice between surgery and SRS is made based on patient condition and tumor location or size. WBRT is still the treatment of choice for patients with multiple brain metastases. Systemic therapy has effect on the central nervous system (CNS) and produces response with or without the combination of WBRT. Temozolomide as single agent treatment has only modest activity on patients with recurrent or progressive brain metastases. After combing with WBRT, it improved response rate, but not survival. Only a few reports demonstrated that epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) could be active on brain metastases in NSCLC patients. Phase III brain metastasis treatment trials using new radiosensitizing medications, such as motexafin gadolinium, are ongoing. Prophylactic cranial irradiation in treating patients with stage III NSCLC is still controversial because the benefit and risk are unclear. Further advances in the understanding of the metastatic cascade may lead to new treatment modalities and better prognoses for patients with metastatic brain disease. ? Nova Science Publishers, Inc.
SDGs
Other Subjects
carcinoembryonic antigen; chloroethylnitrosourea; cisplatin; corticosteroid; efaproxiral; epidermal growth factor receptor kinase inhibitor; erlotinib; etoposide; fotemustine; gadolinium texaphyrin; gefitinib; navelbine; neuron specific enolase; scatter factor receptor; tegafur; temozolomide; tumor marker; age distribution; angiogenesis; article; basic score for brain metastasis; brain edema; brain metastasis; cancer combination chemotherapy; cancer control; cancer localization; cancer patient; cancer prognosis; cancer radiotherapy; cancer recurrence; cancer size; cancer staging; cancer surgery; cancer survival; cancer therapy; clinical assessment tool; clinical decision making; computer assisted tomography; corticosteroid therapy; dementia; disease association; disease marker; gene amplification; gene expression; graded prognostic assessment; human; image analysis; intermethod comparison; lung non small cell cancer; nervous system function; nonhuman; nuclear magnetic resonance imaging; pathophysiology; radiotherapy; recursive partitioning analysis; risk assessment; score index for radiotherapy; stereotactic radiosurgery; survival time; treatment outcome; whole brain radiotherapy
Type
journal article